My mother was wearing lipstick, and when she kissed Sean’s cheek, it broke out in hives,” said his mother, Jennifer Batson. 

At his first birthday party, Sean had a severe allergic reaction — hives, swollen eyes, vomiting and wheezing — to his first nibble of cake. And when a toddler with an ice cream cone touched Sean’s arm with sticky hands during a play date, the arm erupted in hives. 

The daily struggle of living with Sean’s allergies to nearly unavoidable foods and food products — soy, eggs and milk, traces of which can turn up even in nonfoods like lipstick — prompted Mrs. Batson and her husband, Tim, to participate in a project that scientists are calling the most comprehensive food allergy study to date. 

The international study, led by Dr. Xiaobin Wang and Dr. Jacqueline A. Pongracic of Children’s Memorial Hospital here, is searching for causes of food allergy by looking at hundreds of families in Boston, Chicago and Anhui Province in China. 

Using questionnaires and interviews, the investigators are gathering data on a broad range of environmental, genetic and health factors, among them diet, hygiene, number of pets and the children’s prenatal and postnatal medical histories. 

Dr. Wang says the study’s multicenter design allows researchers to look at startling variations in the prevalence and types of food allergies across diverse populations and regions. 

In China, for example, skin-prick testing found that large percentages of one rural population were sensitive to shellfish (16.7 percent) and peanuts (12.3 percent). Yet actual food allergies in that population, as diagnosed by physicians, were all but unheard of: less than 1 percent. 

In the United States, by contrast, 12 million people (4 percent of the population) suffer from food allergies, according to the Food Allergy and Anaphylaxis Network, a nonprofit information and advocacy group. 

“We found something unexpected,” said Dr. Wang, director of the Smith Child Health Research Program at Children’s Memorial. “The apparent dissociation between high allergic sensitization and low allergic disease in this Chinese population is not seen in our two U.S. study populations. 

“What can explain the U.S. and China difference?” she asked. “Is it urban versus rural exposure? Diet and lifestyle? Or genetic susceptibility? These are all questions we are trying to find some clear answers for.” 

For Sean Batson and his family, a recent clinical evaluation at the hospital included a skin-prick test to establish baseline data for Sean’s sister, Audrey, 1, who does not seem to have food allergies. (Neither do their parents, Tim Batson, 38, a computer programmer, and Jennifer Batson, 36, a copy editor.) 

Sean was given a fresh skin-prick test, too. The mild discomfort was tempered by an episode of “SpongeBob SquarePants” playing on a minimonitor affixed to a cushy reclining chair. 

Dr. Wang said her own awareness of food allergies was heightened after her twin sons started kindergarten in Boston and began bringing home an abundance of notes warning of severe food allergies among their classmates. 

“Going back 10 to 15 years ago, during my pediatric residency training, there was very little education about food allergies,” said Dr. Wang, one of 12 principal investigators who were recently awarded grants by the National Institutes of Health to conduct innovative research on food allergies. 

Indeed, with recent data showing a marked increase in the number of food allergies, which cannot be explained by a lack of detection in years past, the institutes have begun an initiative to address food allergies as an emerging health challenge. 

Although it is possible to be allergic to any food, eight foods account for 90 percent of all reactions — milk, eggs, peanuts, fish, shellfish, soy, wheat, and tree nuts like cashews and almonds. 

Up to 200 deaths each year are attributed to the most severe reaction, food-induced anaphylaxis, which also results in 30,000 trips to the emergency room. Some experts suggest that children in a culture smitten with antibacterial detergents and hand sanitizers are exposed to fewer germs, depriving the immune system of its germ-fighting job and leading it to misidentify certain foods as foreign. 

But that is still just a hypothesis, and many researchers say the causes of food allergies are highly complex, and the “hygiene hypothesis” cannot be the sole explanation. 

Dr. Pongracic, who has been treating children with food allergies for 17 years, says even trace amounts of allergens can cause life-threatening reactions. 

“Ultimately, we hope that our research will lead to the discovery of ways to predict which child is likely to outgrow food allergy,” she wrote in an e-mail message, adding that doctors hoped to develop therapies “that can lessen the severity of an allergic reaction, and even protect against the reaction in the first place.” 

Frustration over the lack of financing for food allergy research led one Chicago-area couple, David and Denise Bunning, to donate $3 million to the study at Children’s Memorial. As the parents of two sons with life-threatening food allergies, they say they hope to convince lawmakers that food allergies deserve as much public attention as other chronic childhood diseases like asthma and Type 1 diabetes. 

“At first I thought, ‘O.K., you have this one-in-a-million kid with severe food allergies, and you just have to cope,’ ” said Mr. Bunning, a financial trader. “But when we learned that both Bryan and Daniel had severe food allergies, there was a lot of disbelief. It felt like we were hiding from a phantom.” 

Mrs. Bunning, a former teacher, added: “Now, we’re pretty excited about the future findings of the allergy study. We need to start looking at food allergies not as something you pick and choose as a parent, but as a childhood disease with potentially life-threatening reactions, even death.” 

(New York Times, December 8, 2008) Read the article here

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The threat of nut allergies has led some schools to put precautions into place that approach the level of hysteria, a researcher here said.  Citing the evacuation and cleaning of a bus full of 10-year-olds because of a single peanut on the floor, Nicholas Christakis, M.D., Ph.D., M.P.H., of Harvard, said that measures such as these amount to mass psychogenic illness — also known as “epidemic hysteria.”  Some schools have not only banned nuts and nut products, but also homemade baked goods and foods without detailed lists of ingredients, he wrote in a commentary published online in BMJ. 

Not only is there no evidence that drastic measures like removing nuts from schools are effective or worth the cost, according to Dr. Christakis, exaggerated responses may actually worsen the problem by increasing sensitization to the allergens. 

According to Dr. Christakis, the extreme reactions to nut allergies in schools have similarities to mass psychogenic illness, which is characterized by a “cascade of anxiety” in otherwise healthy people prompted by fears of contamination. He suggested, instead, “using a calm and authoritative approach.” 

The drastic action of banishing nuts and nut products from school grounds can contribute to the problem in two ways — by increasing sensitivity to nuts and by fueling anxiety among parents, he said. 

Anxious parents have their children tested, and when minor nut allergies are detected, more avoidance is encouraged, he said. 

He said such responses are excessive considering the minimal risk associated with food allergies. Among the 3.3 million Americans who are allergic to nuts, each year 2,000 children and adults are hospitalized for it and 150 die from all food allergies combined. 

By comparison, he noted that each year 45,000 people die in car accidents, 2,000 children drown, and 1,300 children are killed in accidental shootings. 

“The cycle of increasing anxiety, draconian measures, and an increasing prevalence of nut allergies must be broken,” Dr. Christakis said. 

Calman Prussin, M.D., head of the Adverse Reactions to Vaccines and Biologics Unit of the National Institute of Allergy and Infectious Diseases in Bethesda, Md., agreed with Dr. Christakis’ point that the way schools deal with risks is not always rational. 

“We don’t tend to make our risk assessments in a very sensible way, whether it’s as individuals or as a society,” he told MedPage Today. 

There is some evidence to support the contention that strict avoidance can worsen events. A study published in the November issue of the Journal of Allergy and Clinical Immunology found that earlier and more frequent consumption of peanuts or peanut butter may reduce the risk of peanut allergy, contrary to conventional thinking. (See: Early and Frequent Peanut Consumption Linked to Lower Goober Sensitivity) 

However, according to Dr. Prussin, the question about whether avoidance or exposure to peanuts increases risk of developing a peanut allergy remains unanswered. “The bottom line is we don’t have enough information,” he said. 

He did not make any specific recommendations, but guidelines issued by the National School Boards Association, the Food Allergy & Anaphylaxis Network, the National Association of Secondary School Principals, the National Association of School Nurses, and the National Association of Elementary School Principals outline steps that parents and schools can take to reduce the risk of serious allergic reactions to foods. 

The family’s responsibility includes: 

Notifying the school about the child’s allergies 

Developing a plan to accommodate the child’s needs, including a food allergy action plan  Providing written medical documentation of the allergy 

Providing medications and replenishing them as necessary Educating the child about recognizing safe and unsafe foods, ways to minimize exposure, and symptoms of allergic reactions 

Reviewing procedures with the school staff, the child’s physician, and the child after a reaction occurs  The school staff should: Be aware of and follow applicable laws addressing food allergy Review health records of allergic students 

Include affected children in all school activities Create a team to work with the child and family in establishing a prevention plan 

Ensure that all medications are stored properly Practice the food allergy action plan before a reaction 

Educate all individuals who will come into contact with the child about food allergies Enforce a “no eating” policy on school buses 

In addition, the child should not trade food with others or eat anything with unknown ingredients, should be proactive in managing the allergy, and should notify an adult if anything with unknown ingredients is eaten. 

Absent from the guidelines and the practice parameters on managing food allergy from the American Academy of Allergy, Asthma, and Immunology is a recommendation to completely avoid eating nuts. 

Despite such a clear plan, however, a study presented at the 2008 AAAAI meeting in Seattle suggested that food allergy action plans may be lacking in many schools. 

In a survey of elementary and middle school nurses in the Greenville, S.C., area, 40% said they didn’t have food allergy action plans for at least half of their allergic students (See: ACAAI: Schools Earn Poor Grade on Food Allergy Action Plans) 

(MedPageToday, December 10, 2009) 

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Pregnant mothers can eat peanuts, the FSA has advised. The Food Standards Agency (FSA) last night recommended that the Government drop its long-standing warning to mothers to avoid the nuts. 

A review by the Committee on Toxicity (COT) found no evidence that children whose mothers ate peanuts during or in the years immediately after pregnancy were at greater risk of nut allergies. 

The FSA’s new guidelines, which will be submitted to the Department of Health, reject existing advice that parents with a family history of food allergies, eczema, hay fever or asthma should not eat the nuts, or give them to their young children. 

“For high-risk groups there is no need for women who are pregnant or breastfeeding or who have children aged under three to change their diets,” the FSA said. 

“Where there is a family history of allergy, parents might want to discuss their individual case with their GP or health professional if they are concerned.” 

The statement added: “The new review considered by the COT does not suggest that this current advice is harmful. However, the FSA Board has agreed that the balance of evidence now available does not support continuing to follow this current advice.” 

The revised advice following warnings this week that fears over nut allergies are creating mass “hysteria” and causing schools to overreact to the dangers. Prof Nicholas Christakis of the Harvard Medical School said that draconian measure imposed to prevent children coming into contact with nuts were out of all proportion to the risks. “The issue is not whether nut allergies exist or whether they can occasionally be serious… The issue is what accounts for the extreme responses to nut allergies and what to do about the responses and the allergies themselves,” he said. 

Last year the House of Lords science and technology committee recommended that the official advice be changed, after research from the University of Portsmouth showed that many first-time mothers were needlessly avoiding peanuts even when there was no family history of allergies. 

Around one in 200 of the population suffers from peanut allergy, according to the British Nutrition Foundation. The most common symptoms are facial tingling and swelling, nausea and tightness of the throat, although it can be fatal in a minority of extreme cases. The latest figures show 79 people died from allergic reactions in 2004, but data is not held in Britain on how many people died specifically from nut allergies. 

A Department of Health spokesman said: “We are awaiting the FSA Board’s formal advice before making a decision about revising the current policy.” 

This is the second time this year that official advice on what women can eat and drink during pregnancy has been rewritten. In April mothers-to-be were told they should not drink any alcohol at all, reversing previous advice that one-and-a-half units a day was safe. 

(Telegraph.co.uk, December 10, 2008) 

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Here’s a health tip in a nutshell: Eating a handful of nuts a day for a year — along with a Mediterranean diet rich in fruit, vegetables and fish — may help undo a collection of risk factors for heart disease.

Spanish researchers found that adding nuts worked better than boosting the olive oil in a typical Mediterranean diet. Both regimens cut the heart risks known as metabolic syndrome in more people than a low-fat diet did.

“What’s most surprising is they found substantial metabolic benefits in the absence of calorie reduction or weight loss,” said Dr. JoAnn Manson, chief of preventive medicine at Harvard’s Brigham and Women’s Hospital.

In the study, appearing Monday in the Archives of Internal Medicine, the people who improved most were told to eat about three whole walnuts, seven or eight whole hazelnuts and seven or eight whole almonds. They didn’t lose weight, on average, but more of them succeeded in reducing belly fat and improving their cholesterol and blood pressure.

Manson, who wasn’t involved in the study, cautioned that adding nuts to a Western diet — one packed with too many calories and junk food — could lead to weight gain and more health risks. “But using nuts to replace a snack of chips or crackers is a very favorable change to make in your diet,” Manson said.

The American Heart Association says 50 million Americans have metabolic syndrome, a combination of health risks, such as high blood pressure and abdominal obesity. Finding a way to reverse it with a diet people find easy and satisfying would mean huge health improvements for many Americans, Manson said.

Nuts help people feel full while also increasing the body’s ability to burn fat, said lead author Dr. Jordi Salas-Salvado of the University of Rovira i Virgili in Reus, Spain.

“Nuts could have an effect on metabolic syndrome by multiple mechanisms,” Salas-Salvado said in an e-mail. Nuts are rich in anti-inflammatory substances, such as fiber, and antioxidants, such as vitamin E. They are high in unsaturated fat, a healthier fat known to lower blood triglycerides and increase good cholesterol.

More than 1,200 Spaniards, ranging in age from 55 to 80, were randomly assigned to follow one of three diets. They were followed for a year. The participants had no prior history of heart disease, but some had risk factors including Type 2 diabetes, high blood pressure and abdominal obesity.

At the start, 751 people had metabolic syndrome, about 61 percent, distributed evenly among the three groups.

Metabolic syndrome was defined as having three or more of the following conditions: abdominal obesity, high triglycerides, low levels of good cholesterol (HDL), high blood sugar and high blood pressure.

The low-fat group was given basic advice about reducing all fat in their diets. Another group ate a Mediterranean diet with extra nuts. The third group ate a Mediterranean diet and was told to make sure they ate more than four tablespoons of olive oil a day.

Dietitians advised the two groups on the Mediterranean diet to use olive oil for cooking; increase fruit, vegetable and fish consumption; eat white meat instead of beef or processed meat; and prepare homemade tomato sauce with garlic, onions and herbs. Drinkers were told to stick with red wine.

After one year, all three groups had fewer people with metabolic syndrome, but the group eating nuts led the improvement, now with 52 percent having those heart risk factors. In the olive oil group, 57 percent had the syndrome. In the low-fat group, there was very little difference after a year in the percentage of people with the syndrome.

The nut-rich diet didn’t do much to improve high blood sugar, but the large number of people with Type 2 diabetes — about 46 percent of participants — could be the reason, Salas-Salvado said. It’s difficult to get diabetics’ blood sugar down with lifestyle changes alone, he said.

To verify that study volunteers ate their nuts, researchers gave some of them a blood test for alpha-linolenic acid found in walnuts.

The study was funded by the Spanish Ministry of Health and the government of Valencia, Spain.

Salas-Salvado and another co-author disclosed in the publication that they are unpaid advisers to nut industry groups. Salas-Salvado said all of their research “has been conducted under standard ethical and scientific rules” and that peer-review journal editors determined the study results were not influenced by food industry ties.

(Associated Press, December 10, 2008)
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See also:
(USA Today, December 8, 2008)
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By Karen Bridgers

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